CPT 19342: Breast Implant Insertion or Replacement After Mastectomy

CPT code 19342 represents insertion or replacement of a breast implant performed after a prior mastectomy. This reconstructive procedure is an essential component of post-mastectomy care and has national relevance for surgical practices, oncology care teams, and payer coverage policies. Decisions about implant reconstruction affect patient recovery, aesthetic outcomes, and care coordination between surgical and oncologic services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 19342, typical settings where the procedure is performed, and the main payer landscape. The publication outlines common billing considerations, commonly applied modifiers (list provided in input), and where to look for documentation and coding guidance.

This summary provides benchmarks and policy context relevant to hospitals and ambulatory surgical centers, highlights factors that influence site-of-service decisions, and summarizes documentation elements that commonly accompany reconstructive implant procedures after mastectomy. Data not available in the input is noted where applicable.

Billing Code Overview

CPT code 19342 describes a procedure in which, after a prior mastectomy (breast excision), a provider inserts or replaces a breast implant. This service is a breast reconstruction procedure performed following mastectomy and is typically classified as reconstructive surgery.

Service type: Reconstructive breast surgery (implant insertion or replacement following mastectomy)
Typical site of service: Ambulatory surgical center or inpatient/outpatient hospital surgical setting, depending on clinical complexity and patient needs.

Data not available in the input.

Clinical Context

A 52-year-old female who underwent a unilateral mastectomy for breast cancer two years prior presents for staged reconstruction. The patient previously had a tissue expander placed at the time of mastectomy and has completed adjuvant chemotherapy and radiation. At this visit, the plastic surgeon performs surgery to remove the tissue expander and insert a permanent silicone gel breast implant under the pectoralis major muscle. The surgical workflow includes preoperative verification, informed consent for implant exchange, general anesthesia, removal of the expander, pocket irrigation and assessment, insertion and positioning of the permanent implant, hemostasis, layered closure, and standard postoperative recovery and discharge instructions.

The typical site of service is an outpatient ambulatory surgery center or hospital outpatient department. Typical supporting clinicians include a board-certified plastic surgeon (primary operator), an assistant surgeon or physician assistant as indicated, a certified registered nurse anesthetist or anesthesiologist, and perioperative nursing staff. Billing uses 19342 for exchange or insertion of a breast implant performed after mastectomy; documentation should include prior mastectomy history, reason for exchange (definitive reconstruction, capsular contracture, infection resolution, implant rupture), details of implant type and size, laterality, and any additional procedures performed during the same operative session.

Coding Specifications

Modifier	Description	When to Use

Taxonomy Code	Specialty	Notes
`2084P0805X`	Plastic Surgery	Board-certified plastic surgeons perform breast reconstruction and implant exchange procedures
`207P00000X`	General Surgery	General surgeons may be involved when oncologic re-operation or mastectomy revisions are required
`363A00000X`	Anesthesiology	Provides general anesthesia or monitored anesthesia care for the procedure
`206E00000X`	Physician Assistant	May assist intraoperatively under surgeon supervision
`367A00000X`	Registered Nurse First Assist	May function as an assistant in the operative field when credentialed

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z42.1`	Encounter for breast reconstruction following mastectomy	Common reason for implant insertion or exchange after prior mastectomy
`C50.919`	Malignant neoplasm of unspecified site of unspecified female breast	Underlying breast cancer diagnosis that may have led to prior mastectomy and subsequent reconstruction
`T85.698A`	Other complications of breast prosthesis, initial encounter	Codes complication scenarios such as malposition, rupture, or pain prompting implant replacement
`T86.898`	Other complications of transplanted organ and tissue, initial encounter	Occasionally used for complex implant-related complications when tissue issues arise
`Z43.3`	Encounter for attention to other plastic and reconstructive operations on the skin	Administrative code used for subsequent reconstructive procedures including implant exchange

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19357`	Breast reconstruction with tissue expander, placement	Performed earlier in a staged reconstruction; the expander may be the item exchanged during `19342`
`11970`	Replacement of tissue expander with permanent implant	Alternative code sometimes used by payers; documents conversion from expander to implant (ensure correct reporting per payer rules)
`19318`	Reduction mammaplasty	May be performed concurrently if contralateral symmetry procedures are required during reconstruction
`19499`	Unlisted breast procedure	Used only when a billed service related to breast reconstruction cannot be accurately described by existing codes (rare for standard implant exchange)
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., for diagnostic or therapeutic injections)	Not directly related but included occasionally for coding crosswalks when coding adjunctive procedures; generally not used for implant exchange

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Summary & Overview